(SCHOOL / INSTITUTION)

(SCHOOL ADDRESS)

INFLUENZA VACCINATION STUDY: FACTORS THAT AFFECT

BAESA ADVENTIST ACADEMY SENIOR HIGH SCHOOL
STUDENTS AND PARENT’S DECISION-MAKING

A Research Paper
Presented to

(Professor’s Name)
Research 2 Instructor
(School / Institution)

As a Partial Fulfilment
Of the Requirements
in Research 2

By

Francheska Nadine Magoncia

May 8, 2020
 ACKNOWLEDGEMENT

To begin with, the researchers would like to thank God for pondering upon

knowledge, wisdom, and understanding on them while conducting the study, and

for the ideas, He has bestowed upon the researchers. Furthermore, for the strength

to overcome these challenges for this research to be successful.

Second, the researchers acknowledge the respondents who have put effort

and support into participating in this study. Without the participation of the

respondents, this research paper would not be complete.

This acknowledgment would not be complete without Sir Reily Leonardia

who guided the researchers to finish this study and who advised on what to do

that made this study more accurate and more pleasing to the readers and to future

researchers. He mentored the researchers to put the appropriate content and he

provided enough time to finish the research paper.

Additionally, the researchers would also like to give appreciation to RG

Daniel Undan. He has shown his support to the researchers by helping them

compute the data and by mentoring them with regards to the research presentation

or defense.

Lastly, the researchers gladly gave admiration to their parents for giving

them knowledge, advice, and inspiration. As well as supporting the researchers

physically, mentally, emotionally, financially, and for the motivation to finish the

study.
 TABLE OF CONTENTS

CHAPTER 1- Introduction

Introduction…………………………….……………………………1

Background of the Study………….…………………………………2

Statement of the Problem …………………………………………...3

Research Paradigm ………………………………………………….4

Hypotheses ………………………….………………………………4

Scope and Delimitations of the Study …….………………………...5

Definition of Terms ….……………………………………………...6

CHAPTER 2- Review of Related Literature

Components of Vaccine….………………………………………….7

How does a vaccine work………………………………………8

Types of flu vaccine…………………………………………….9

Ingredients of flu vaccine………….…..………………………10

What are boosters for…………...………………………..….…12

Health Literacy……………………………………………...12

How is the public…………....…………………………………12

Influences.…………………..…………………………………..13
 Medical Conditions…………………….….………………………..15

Sex……………………….………………….………………………17

Influenza Infection and Vaccine in Women………..………….18

Influenza Infection and Vaccine in Men…………..…………...19

Genetic/ Biological Differences in Response to Vaccine.……..19

Age………………….….……………..……………………………..20

Effects of flu vaccine on children………………….…………..20

Effects of flu vaccine on elders……..………………………….21

Socio-Economic Status………….………..…………………21

Who are the affected……………….…………………………..23

Healthcare Expenses………………….……..……..……….24

Rising cost of healthcare……..………………………………...24

Healthcare Facilities………..………………....…………….26

Importance of healthcare facilities………….…………………26

CHAPTER 3- Methodology

Research Design ………………………………………………………….27

Research Instrument ………………………………….…………………...27

Data Gathering Procedure …………….………………………………….28

Data Analysis ……………………………………………………………28

CHAPTER 4 -Presentation, Analysis, and Interpretation of Data

Introduction ……………………………………………….…………….29

Analyses of Tables……………………………………………………..30-42

CHAPTER 5

Summary of Findings …………………………………………………43-44

Conclusion …………………………………………...………………….44

Recommendation ……………………………………………………...44-45

Bibliography and Reference

 CHAPTER 2

INTRODUCTION

Influenza is a highly contagious airborne disease that attacks the respiratory

system. If the virus overwhelms the lungs, it results in respiratory failure leading

to death. A flu vaccine is therefore inoculated to people to protect them from the

flu. A short history of flu virus from weather.com says that, a long time ago,

scientists thought the flu vaccine was from the virus called Haemophilus

influenzae but years passed and they found out it is really a virus. In the year

1933, three scientists isolated the Influenza A virus in ferrets, a domesticated

polecat and in 1936, it was discovered that the virus could be grown inside

embryonated chicken eggs, a key step towards making a vaccine. Just two years

later, in 1938, Jonas Salk (who would later develop the Polio vaccine) and

Thomas Francis developed the first vaccine using fertilized chicken eggs and an

inactivated strain of the Influenza A virus. Despite the setback of the flu vaccine

in the past years, production continued and is trying to improve each year. With

the adverse effects of the vaccine, it then reviews the epidemiological, clinical,

and biological evidence regarding adverse health events associated with the given

vaccine (pubmed.ncbi.nlm.nih.gov)

Vaccines are recommended for children, teens, and adults based on different

factors like age, health conditions, lifestyle, jobs, and travel, especially in this time

of pandemic 2020. Opponents say that the immune system can deal with most

infections and diseases naturally and that injecting questionable vaccine

ingredients into a person may cause side effects. But with the world’s changing

environment,
 1

prevention is better than cure, and the vaccine has preserved millions of children's

lives. Proponents say that vaccination is safe and one of the greatest health

developments of the 20th century. (vaccines.procon.org).

Background of the Study

Due to the ongoing pandemic, getting a flu vaccine will not protect the

population against COVID-19. There are medical groups urging people to get the

flu shot so that doctors and hospitals do not face the extra strain of having to treat

influenza amid the coronavirus pandemic. The objective of this study is to

determine the factors that influence the decision-making in influenza vaccination of

Baesa Adventist Academy senior high school students and of their parents.

Besides, it aims to answer the following research questions:

1. How does accessibility limit ones’ opportunity to be inoculated in terms of?

a. Health-care expenditure
b. Socio-economic status
c. Public health facility

2. Is there a noticeable difference in terms of?

a. Gender
b. Age
c. History
d. Conditions

3. How does information and knowledge affect ones’ decision to have a vaccine
in terms of:
a. Personal Experience
b. Components of Vaccine
c. Social media influence
d. Health literacy
2
Statement of the Problem an apple a day keeps the doctor red velvet duh

A lot of people are not aware enough and are in confusion whether they

want to get vaccinated or not. Those may be the effects of not having enough

knowledge and awareness of what influenza vaccine can do to their physical

health whether it could bring an adverse or a favorable influence. This research

paper aims to tackle the different factors that affect patients’ perspectives and

decision making on vaccination. The chosen study will be furtherly discussed by

the means of some research inquiries indicated below:

1. What is the demographic profile of the respondents in terms to their:

a. Age

b. Gender

c. Type of Respondents

2. Will the decision-making of the students and of the parents be affected in

terms of:

a. Information and Knowledge;

b. Accessibility; and

c. Patient Factor

3. Is there a significant relationship between the independent variables and the

dependent variable?

3
Research Paradigm

INDEPENDENT VARIABLES DEPENDENT VARIABLE

Information and Knowledge

a. Experience
b. Components of vaccines
c. Health literacy VACCINATION
DECISION-
---
Accessibility MAKING
a. Healthcare expenses
b. Socio-economic status
c. Public health facility

Patient Factor
a. medical
conditions/history
b. sex
c. age

MODERATING VARIABLES

Figure 1. Conceptual Paradigm of the Study

Hypotheses

1. There is a significant relationship between the information & knowledge and

their decision-making.

2. Accessibility does have an impact to their vaccination decision making.

3. There is a relationship between patient’s factors and decision making.

4
 Null Hypotheses

1. There is no significant relationship between the information & knowledge and

their decision-making.

2. Accessibility does not have an impact to their vaccination decision making

3. There is a relationship between patient’s factors and decision making.

Scope and Delimitations of the Study

Conducted in the year 2020-2021, this study chiefly focuses and aims to

provide facts and evidence from relevant and reliable sources that would ponder

upon the citizens' awareness about the factors that affect the population’s

decision-making in influenza vaccination. This research paper will be significant

to people who are seeking information that evaluates on whether they should be

vaccinated or not in hope to correlate to the global COVID-19 pandemic. The

respondents will come from the selection of Baesa Adventist Academy senior

highs and their parents who are mature enough to participate in the study
 5

Definition of Terms

 Influenza- is a viral infection that attacks respiratory system — nose, throat,

and lungs.

 Contagious- capable of being transmitted by bodily contact with an infected

person or object

 Inoculation- an act of being vaccinated.

 Haemophilus influenzae- a bacteria responsible for severe pneumonia,

meningitis, and other invasive diseases almost exclusively in children aged less

than 5 years.

 Antigen- any substance that induces the immune system to produce antibodies

against it

 Chronic Obstructive Pulmonary Disease- a chronic inflammatory lung

disease that causes obstructed airflow from the lungs. Symptoms include

breathing difficulty, cough, mucus (sputum) production and wheezing.

 6

CHAPTER 2

REVIEW OF RELATED LITERATURE

COMPONENTS OF VACCINE

Every flu season is different, and influenza infection can affect people

differently, but millions of people get flu every year, hundreds of thousands of

people are hospitalized and thousands to tens of thousands of people die from flu-

related causes every year. This is due to the antigenic drift and antigenic shift.

Changes associated with antigenic drift happen continually over time as the virus

replicates. These are small changes (or mutations) in the genes of influenza

viruses that can lead to changes in the surface proteins of the virus. It is the

primary reason why the flu vaccine composition must be reviewed and updated

each year (as needed) to keep up with evolving influenza viruses. The other type

of change is called “antigenic shift”. Antigenic shift is an abrupt, major change in

an influenza A virus, resulting in new HA and/or new HA and NA proteins in

influenza viruses that infect humans. A one-way shift can happen is when an

influenza virus from an animal population gains the ability to infect humans. And

the best way to protect society against flu is to annually get a flu vaccine. Flu

vaccine causes antibodies to develop in the span of 2 weeks. And these antibodies

provide protection against the threat of flu vaccine. (cdc.gov).

 7

A. How does it work?

To understand how the flu vaccine works, it is vital to understand how the

immune system works. The immune system fights off diseases by remembering

every single disease it has encountered. In response, the body makes antibodies

that tell the white blood cells which infections need to be destroyed. The body can

release antibodies at a moment’s notice to any disease the person ever comes into

contact with; it identifies the offending bacteria or virus and the white blood cells

come in and kills it. Vaccines work by “training” the body’s immune system.

There are two types of vaccines: inactivated, and live/attenuated. Inactivated

vaccines are essentially the protein coat of whatever you are trying to vaccinate

against. Think of it as what the bacteria or virus is “wearing.” Live/attenuated

vaccines are viruses or bacteria that have been weakened. The vaccine is not what

the virus is “wearing,” it’s just a really weak version of the virus itself (dmu.edu).

The content of the vaccine must be immunogenic, meaning that it will be

recognized by the immune system, without being infectious, so that the person

won’t get the disease the vaccine is trying to protect him from. A common way of

inactivating a live microorganism is to use formaldehyde (also known as formalin

or formol). This chemical is very familiar since it is used for preserving organs

and tissues in jars for display in medical museums and biology laboratories.

The immune systems are infinitely adaptable, but the main downside is that it

takes time for it to learn how to fight different infections, which means the person

usually gets sick the first time he gets exposed to something like the flu. Contents

in the flu vaccine can be manipulated, which gives your body the information it

needs to fight something off without getting you sick.

 8

Antibodies are what the body uses to fight infections, and it gets stronger when

the person is exposed it the virus. So, if the person had the flu shot and get

coughed on by someone who has the flu, his immune system has already seen the

flu and has practiced killing it. With that, if the person gets sick, it will be less

severe (healthline.com).

B. Types of Flu Vaccine

According to (cdc.gov) there are eight (8) kinds of flu vaccine:

1. Influenza (flu) shot, most common flu vaccine, a flu vaccine given with a needle,

usually in the arm. Seasonal flu shots protect against the three or four influenza viruses

that research suggests may be most common during the upcoming season.

2. Live Attenuated Flu Vaccine (LAFV) is given as a nasal spray.

3. Quadrivalent influenza (flu) vaccine is designed to protect against four different flu

viruses, including two influenzas A viruses and two influenza B viruses.

4. A jet injector is a medical device used for vaccination that uses a high-pressure,

narrow stream of fluid to penetrate the skin instead of a hypodermic needle.

5. The high dose flu vaccine contains 4 times the amount of antigen (part of the vaccine

that helps the body build protection) as a regular flu shot and is licensed specifically for

people 65 years and older.

6. The cell-based flu vaccine is grown in the cultured cell of mammalian origin instead

of in hens’ eggs.

7. The adjuvanted vaccine is made with an ingredient that helps create a stronger

immune response, it is only recommended for ages 65 and above.

8. Recombinant Flu vaccines are producing from a method that does not require an egg-

grown vaccine virus.

9
C. Ingredients of Flu Vaccine

According to (medicalnewstoday.com) the composition of the flu vaccine:

Formaldehyde

Formaldehyde, a chemical typically present in the human body, is a product of

healthy digestive function. In high doses, formaldehyde is toxic and potentially

lethal. However, the tiny amounts present in flu vaccines are harmless.

Formaldehyde’s role in a flu shot is to inactivate toxins from viruses and bacteria

that may contaminate the vaccine during production.

Aluminum salts

Aluminum salts are adjuvants — they help the body develop a stronger

immune response against the virus in the vaccine. This allows scientists to include

smaller amounts of the inactivated influenza viruses in these vaccines. As with

formaldehyde and most ingredients in flu shots, the amount of aluminum present

is extremely small. Aluminum salts are also in drinking water and various health

products, such as antacids and antiperspirants. They are not always present in flu

vaccines, some of which are aluminum-free.

Thimerosal

Thimerosal is a preservative, and it keeps vaccines from becoming

contaminated. This ingredient is only present in multi-dose vials, which contain

more than one dose. Without it, the growth of bacteria and fungi are common in

these vials. Single-dose vials, prefilled syringes, and nasal sprays do not need a

preservative, because the risk of contamination is so low. Thimerosal has been

safely included in vaccines since the 1930s. It comes from an organic form of

10
mercury called ethyl mercury, a safe compound that — unlike other forms of

mercury — does not remain in the body. Ethyl mercury is different from the

standard form of mercury that can cause illness in large doses, and it is also

different from the mercury found in seafood, called methylmercury, which can

stay in the body for years.

Chicken egg proteins

These proteins help the viruses grow before they go into the vaccine. The

inactivated influenza viruses present in vaccines are usually grown inside

fertilized chicken eggs, where the virus replicates. Then, the manufacturers

separate the virus from the egg and include it in the vaccine. As a result, the

finished vaccine may contain small amounts of egg proteins. The CDC says that

people with egg allergies can receive the standard flu vaccine, but that those

severe allergies should do so in a supervised medical setting. Egg-free flu shots

are also available.

Gelatin

Gelatin is present in the flu shot as a stabilizer — it keeps the vaccine effective

from the point of production to the moment of use. Stabilizers also help protect

the vaccine from the damaging effects of heat or freeze-drying. Most flu vaccines

use pork-based gelatin as a stabilizer.

Antibiotics

Antibiotics in flu vaccines keep bacteria from growing during the production

and storage of the products. Vaccines do not contain antibiotics that can cause

severe reactions, such as penicillin. Instead, they contain other forms, such as

gentamicin or neomycin, which is also an ingredient in many topical medications,

such as lotions, ointments, and eye drops.

 11

1. What are boosters for?

After initial immunization, a booster injection or booster dose is a re-exposure

to the immunizing antigen. It is intended to increase immunity against that antigen

back to protective levels after memory against that antigen has declined through

time (en.wikipedia.org). A study conducted in 2012 proved that two doses of the

influenza vaccine could have positive effects in protecting these individuals

against influenza (passporthealthusa.com). The booster dose then causes a

secondary immune response and the production of more long-lived plasma cells.

That is how we get higher l

levels of protective antibodies that will last longer. (vaxopedia.org)

HEALTH LITERACY

Being aware of one's health is essential in marinating his/her overall well-

being. According to The National Academies of Sciences, Engineering, and

Medicine define health literacy as “the degree to which individuals have the

capacity to obtain, process, and understand basic health information and services

needed to make appropriate health decisions (www.empowher.com) There is

complexity on why people refuse a proven intervention that has demonstrably

enhanced health globally. The scientific, medical, and public health establishment

continues to provide evidence of the value of immunization (hbr.org)

A. How is the public?

Effective and proven health benefits of vaccination improve quality and

access and is a key to preventing disease (hbr.org). Vaccine hesitancy is the delay

in acceptance or refusal of vaccines despite the availability of vaccination

 services (researchgate.net).

12

Reducing vaccine hesitancy and increasing confidence in vaccinations could help

improve vaccination coverage and thus protect children from disease

(webmd.com) When enough individuals in a population are immune to a disease,

as would occur if a large proportion of a population were vaccinated, herd

immunity is achieved. Herd immunity acts by breaking the transmission of

infection or by lessening the chances of susceptible individuals coming in contact

with a person who is infectious. Herd immunity provides a measure of protection

to individuals who are not personally immune to the disease—for instance,

individuals who, because of their age or underlying medical conditions, cannot

receive vaccines or individuals who received vaccines but remain susceptible

(britannica.com)

B. Influences

According to (vtechworks.lib.vt.edu), people are exposed to the media’s

influence from early on in life. Media here refers to all the types of technology

that are used for mass communication (Internet, newspapers, radio, etc.) and those

that control the technology. The primary media used to influence people

concerning vaccination are public health publications, anti-vaccination websites,

medically related television shows, and interfaces. And these media have a lot to

say about the public’s perception of vaccines. With so much confusing and even

misleading information about vaccine safety available everywhere, it’s no

surprise that parents are easily influenced by what they see when it comes to

immunizing their kids (healthland.time.com) Still, experts in online

misinformation say the impact of social networking and its unfiltered,

algorithmically boosted dissemination of the most “engaging” posts — whether

true or not — have fueled a much broader spread of anti-vaccination propaganda

(pbs.org).

13

Many anti-vaccination websites have images and pictures whose purpose it

is to influence and persuade. A study published by the Journal of the American

Medical Association observed that 32% of anti-vaccination websites surveyed had

pictures of “menacing needles” and 23% of anti-vaccination websites surveyed

had pictures of children who were reported to be harmed or killed by adverse

reactions to a vaccine (Wolfe, Sharp, and Lipsky 3247). Social psychology

explains that disturbing visual images can cause parents to fall victim to “false

consensus bias” in which they place more emphasis on personal and emotional

experience at the expense of scientific evidence when making decisions (Wolfe,

Sharp, and Lipsky 3247).

In the study, researchers surveyed 196 parents of children 18 months or

younger in King County — Haight’s stomping ground — which has a vaccination

rate that is typically below the national average. At least 95% of parents in both

groups indicated that they had consulted their “people network” for insight into

making vaccination decisions. Parents reported they paid the most attention to

their spouse or partner’s opinion. Pediatricians were next in line, followed by

friends and relatives. (Interestingly, 10% of parents who followed CDC

guidelines — the “conformers” — and 12% of parents who didn’t — the “non-

conformers” — failed to list doctors among the top five people in their network.)

Here is why that is important: 72% of non-conformers’ friends and relatives

advised them to disregard CDC recommendations compared with just 13% of

conformers’ friends and family members. In other words, changing parents’

attitudes about vaccines may be a matter of influencing the people who are

influencing parents in the first place (healthland.time.com).

14

Coincidental, temporal relationships to adverse health outcomes lack trust in

corporations and public health agencies.

MEDICAL CONDITIONS

Who should and who should not get a flu vaccine? In a study conducted in

Saint Paul, Minnesota, vaccination is recommended for all people ages 6 months

and older, including contacts of people with chronic illnesses. According to

Centers for Disease Control and Prevention, it is said that some vaccines are not

recommended in some situations and for people with certain health conditions,

and some people should not receive influenza vaccines at all (though this is

uncommon).

Research by Khun Nanta Maranetra, MD, Phunsup Wongsurakiat, MD,

Chantapong Wasi, MD, et. (2004) concluded that influenza vaccination is highly

effective in the prevention of ARI related to influenza virus infection in patients

diagnosed with chronic obstructive pulmonary disease (COPD) and acute

respiratory infection (ARI), regardless of the seriousness of COPD, comorbid

diseases, age, sex, or current smoking status. COPD is an umbrella term for a

range of progressive lung diseases. Chronic bronchitis and emphysema both can

result in COPD. According to Cleveland Clinic (2020), COPD diagnosis means

you may have one of these lung-damaging diseases or symptoms of both. COPD

can progress gradually, making it increasingly difficult to breathe over time.

While the acute respiratory infection is manifested by cough accompanied by

short rapid breathing which may be associated with death especially when there

are other co-

15

morbidities. From an estimated 5.4 million children under –five years that died in

2017—roughly half of those deaths occurred in sub-Saharan Africa and acute

respiratory infection contributed to the highest number of deaths. (Dagne, H.,

Andualem, Z., Dagnew, B., Taddese, A.A., 2020). People with asthma are at high

risk of developing serious flu complications, even if their asthma is mild or their

symptoms are well-controlled by medication. Centers for Disease Control and

Prevention (2020) discussed in one of their articles that, people with asthma can

develop swollen and sensitive airways, and flu can cause further inflammation of

the airways and lungs. In that case, flu infections can trigger asthma attacks and a

worsening of asthma symptoms.

Meanwhile, a group of pediatrics in American Pediatrics Academy confirms

that children younger than 5 years and particularly children younger than 1 year

have a high burden of hospitalization from the respiratory syncytial virus (RSV),

influenza, and parainfluenza viruses (PIV). The enhanced use of influenza

vaccine and the development of RSV and PIV vaccines have the potential to

reduce markedly the pediatric morbidity from ARIs.

But, on contrary to some studies about the positive effects of the influenza

vaccine, in his article, Bradley van Paridon (2018), states that compared with

unvaccinated children, children who received the influenza vaccine had an

increased risk for acute respiratory infection (ARI) caused by non-influenza

pathogens, according to research published in Vaccine.

 16

SEX

World Health Organization have published a report on 2010 wherein sex and

gender have an impact on people’s vulnerability to influenza, as well as the

course and outcome of infection and vaccination. The impact of sex and gender

on the outcome of infection is influenced by a number of global, social and

biological factors. Sex and gender also have an impact on immune responses and

adverse side effects following vaccination against influenza. Women mount

higher antibody responses and experience more frequent and severe side effects

than men, a finding that should be incorporated into the drafting of guidelines for

vaccination worldwide. The effectiveness of antiviral therapies may also vary in a

sex-dependent manner. According to Biol, J.L. (2012) Males and females also

respond differently to influenza vaccines, with women initiating higher humoral

immune responses but experiencing more adverse reactions to seasonal influenza

vaccines than men. In addition to influenza virus pathogenesis, males and females

differ in response to influenza virus vaccines. Biol, J.L. once conducted an

experimental study in which he used mice as his subject. In his study, it has been

shown that small animal models of influenza virus infection illustrate that

inflammatory immune responses also differ between the sexes and impact the

outcome of infection, with females generating higher proinflammatory cytokine

and chemokine responses and experiencing greater morbidity and mortality than

males.
 17

Males and females also respond differently to influenza vaccines, with women

initiating higher humoral immune responses but experiencing more adverse

reactions to seasonal influenza vaccines than men.

A. Influenza Infection and Vaccine in Women:

Biol, J.L., in another portion of his studies (2012) shows that pregnancy is a

strong female-specific risk factor associated with the poorer outcome of infection

with the seasonal, epidemic, and pandemic influenza virus and is likely to lead to

higher overall morbidity and mortality in women relative to men. Although

pregnancy is important to risk factor, it does not appear to explain all the

variability between the sexes. Passive reporting of local reactions (eg, muscle

pain, redness, and inflammation) to inactivated split or whole influenza vaccines

is consistently more frequent for females than males among both younger and

older adults. (Pekozs, A., Klein, S.L., 2014) Another report by Biol, J.L. (2012)

states that many cases of severe disease also involve comorbid conditions,

including chronic lung disease (e.g., asthma and chronic obstructive pulmonary

disorder), which is typically more severe in females than males, independent of

pregnancy. Public health policies would benefit significantly from considering

sex when making recommendations about prophylaxis and therapeutic treatments

for influenza virus infection. The data reviewed illustrate that as compared with
males: 1) females typically experience greater morbidity and mortality during

influenza outbreaks and pandemics, 2) are less likely to accept vaccines, yet 3)

develop higher immunity and greater protection following vaccination.

18

Public health messages should be designed to increase rates of vaccination and

hence, protection against infection among females.

B. Influenza Infection and Vaccine in Men:

Men are likely to develop fewer antibody responses, and experience less

adverse reactions to influenza vaccines. (Pekozs, A., Klein, S.L., 2014). Research

suggests that women are at greater risk of getting flu than men because they tend

to spend more time around children, who are more likely to have a flu-like illness

in the first place. Ergo, men are much safer than women regarding whom they

interact with. (Roxby, P., 2020)

C. Genetic/ Biological Differences in Response to Vaccine

Males and females are undeniably biologically different. The mechanisms

mediating these differences, both hormonal and genetic factors, can alter immune

responses to infection or vaccination and require further systematic

evaluation. (Pekozs, A., Klein, S.L., 2014) Evolutionary factors and hormonal

differences were thought to make males more susceptible to infection than

females. (Roxby, P., 2020)

A comprehensive study by Pekosz, A. and Klein, S.L., reposts that the

prevailing hypothesis for immunological differences between the sexes is that sex
steroids, particularly testosterone, estradiol, and progesterone, influence the

functioning of immune cells. Sex steroids alter the functioning of immune cells by

binding to specific receptors, expressed in many immune cells, including

19

lymphocytes, macrophages, and dendritic cells. The binding of sex steroids to

their respective steroid receptors directly influences cell signaling pathways,

resulting in differential production of cytokines and chemokines. Sex steroids also

affect migration, proliferation, and activity of CD4+ and CD8+ T cells as well as

antibody production. Sex-based differences in humoral immune responses are

observed before puberty, during the reproductive years, and after reproductive

senescence, suggesting that sex hormones are not the only mediators of sex

differences in humoral immune responses to vaccines. Alternatively, genetic

differences might underlie sex-based differences in adaptive immune responses to

viral vaccines. Some sex differences might cause by the inherent imbalance in the

expression of genes encoded on the X and Y chromosomes. Several immune-

related genes and regulatory microRNAs are encoded on the X chromosome, and

there is some evidence of greater activation of X-linked genes in immune cells

from females than males. Polymorphisms in sex chromosomal and autosomal

genes that encode for immunological proteins also can contribute to sex

differences in immune responses and antibody responses to vaccination.

AGE

A. Children
 Centers for Disease Control and Prevention states that children younger than

five years old–especially those younger than 2– are at high risk of developing

serious flu-related complications. Flu illness is more dangerous than the common

cold for children. Each year, millions of children get sick with seasonal flu;

20

thousands of children are hospitalized, and some children die from the flu.

Children commonly need medical care because of flu, especially children younger

than five years old.

B. Elders

Centers for Disease Control and Prevention states that flu vaccination is

essential for people 65 years and older because they are at high risk of developing

severe complications from the flu. Flu vaccines are updated each season as

needed to keep up with changing viruses. Also, immunity wanes over an annual

vaccination is a must to ensure the best possible protection against flu. An article

by Gross, P.A. et.al, (1995) that despite the paucity of randomized trials, many

studies confirm that influenza vaccine reduces the risks for pneumonia,

hospitalization, and death in elderly persons during an influenza epidemic if the

vaccine strain is identical or similar to the epidemic strain. Influenza

immunization is an indispensable part of the care of persons 65 years of age and

older. The immune systems of older people, as well as those of younger people,

do not respond to flu vaccine, and people 65 years of age and older are at higher

risk of severe complications from the illness (Schnirring L.).

SOCIO-ECONOMIC STATUS
 Pandemic mortality rates in 1918 and in 2009 were highest among those with

the lowest socioeconomic status. Despite this, low SES groups are not included in

the list of groups prioritized for pandemic vaccination, and the ambition to reduce

21

social inequality in health does not feature in international and national pandemic

preparedness plans (Mamelund, Egan, Rogeberg. 2019). Influenza vaccination is

an important public health intervention for controlling disease burden, but

coverage rates are still low also in risk groups. In order to identify non-

vaccinating subgroups, deprivation and socio-economic indices

(pubmed.ncbi.nlm.nih.gov).

Clinician perceptions of patients with low and high socioeconomic status

have been shown to affect clinical decision making and health care delivery in

this group. The households that belong to low socio-economic status groups had

to travel longer distance to get to health facilities consequently incurring some

transportation cost, hence the households from high socio-economic status (rich)

groups utilized routine immunization services more than those that belong to low

socio-economic status (poor) groups. There is evidence that socioeconomic status

(SES) affects individual’s health outcomes and the health care they

receive. People of lower SES are more likely to have worse self-reported health,

lower life expectancy, and suffer from more chronic conditions when compared

with those of higher SES. They also receive fewer diagnostic tests and

medications for many chronic diseases and have limited access to health care due

to cost and coverage. Compared with other patients, physicians are less likely to

perceive low SES patients as intelligent, independent, responsible, or rational and

believe that they are less likely to comply with medical advice and return for

follow-up visits. These physician perceptions have been shown to impact

physicians’ clinical decisions. Physicians delay diagnostic testing, prescribe more

generic medications, and avoid referral to specialty care for their patients of low

SES versus other patients. Some physicians

22

believe that tailoring care options to a patient’s socioeconomic circumstances can

improve patient compliance and thereby improve health outcomes. However,

other studies have shown that physicians believe that the financial and coverage

restrictions faced by low SES patients limit access to care and results in worse

health outcomes for these patients. There are also some physicians who do not

care for patients of lower SES with publicly financed insurance due to low

reimbursement rates. (Arpey, Gaglioti, Rosenbaum. 2017).

A. Who are the affected?

Socioeconomic status is tied to healthcare access among older adults,

perceived or otherwise (Fitzpatrick, Powe, Cooper, Ives, Robbins, 2004).

Variation in healthy aging based on income levels may be attributed to

differential healthcare access: wealthier older adults have better access to care,

and access to care may be associated with better health outcomes (Klabunde,

Joseph, King, White, Plescia, 2013). Poor health-related quality of life outcomes

are significantly associated with lower SES in the United States, which is possibly

driven by limited healthcare access among poorer older adults. In a cross-

sectional study of almost 50,000 non-institutionalized older adults, costs were

cited as a major reason for not obtaining needed care. Older adults living in higher
socioeconomic brackets are more likely to access preventative care and

screenings, with for example, higher SES older adults experiencing a greater

likelihood of having a hearing screen and using a hearing aid. Lower SES is

associated with longer wait times in countries with centralized healthcare systems.

Faced with rising healthcare costs, Japanese older adults report forgoing

healthcare due to limited income.

23

In India, financial instability is a driving factor for lower healthcare access among

older adults

HEALTHCARE EXPENSES

Medical expenses are any costs incurred in the prevention or treatment of

injury or disease. Medical expenses include health and dental insurance

premiums, doctor and hospital visits, co-pays, prescription and over-the-counter

drugs, glasses and contacts, crutches, and wheelchairs, to name a few (Kagan,

2020).

Health spending measures the final consumption of health care goods and

services including personal health care and collective services but excluding

spending on investments. Health care is financed through a mix of financing

arrangements including government spending and compulsory health insurance as

well as voluntary health insurance and private funds such as households’ out-of-

pocket payments (OECD, 2020. Health spending).

A. Rising cost of healthcare

 High insurance premiums, high deductibles, copays, and other out-of-pocket

expenses are just some of the costs associated with health and wellness in the

country. One reason for rising healthcare costs is government policy. Since the

inception of Medicare and Medicaid programs that help people without health

insurance providers have been able to increase prices. On March 2019 a study

was conducted in the Journal of the American Medical Association (JAMA). The

study investigated how five key factors were associated with healthcare increases

over time:

24

 Population growth

 Population aging

 Disease prevalence or incidence

 Medical service utilization

 Service price and intensity

The authors found that service price and intensity, including the rising cost of

pharmaceutical drugs, made up more than 50% of the increase. Other factors,

which comprised the rest of the cost increased, varied by type of care and health

condition (Probasco.2021) and due to this continuous rising of healthcare cost, it

created another casualty which are the people who skip medical care altogether.

They do so not because they are afraid of doctors, but because they are afraid of

the bills that come with healthcare.

A poll by the West Health Institute and NORC at the University of Chicago

revealed that 44% of Americans refused to go to a doctor due to cost concerns.

About 40% of those surveyed said they skipped a test or treatment for the same

reason. In many cases, those who refuse treatment have medical insurance.

Each of the factors mentioned here contribute to rising healthcare costs.

Increasing costs for medical services, caused by both a growing and aging

population play a large role. But so do other factors such as the growing number

of people with chronic disease, increased costs for outpatient and emergency

room care, higher premiums, and higher out-of-pocket costs.

25

HEALTHCARE FACILITIES

Health facilities are places that provide health care. They include hospitals,

clinics, outpatient care centers, and specialized care centers, such as birthing

centers and psychiatric care centers isolation camps, burn patient units, feeding

centers and others. Health-care facilities are often faced with an exceptionally

high number of patients, some of whom may require specific medical care.

Quality is important, some facilities do a better job than others. One way to learn

about the quality of a facility is to look at report cards developed by federal, state,

and consumer groups.

Importance of healthcare facilities

Most health services are found in hospitals, clinics and medical centers run

either by the government or the private sector. Hospitals normally provide

emergency, secondary, and tertiary medical services while health centers provide
primary care and some basic treatment or first aid. Health facilities play a very

significant role in the mitigation of disasters because of their particular function in

treating the injured and handling outbreaks of disease. Geriatric and psychiatric

hospitals are less critical relatively speaking, except when their installations are

damaged or when there is a great psychological impact on individuals in the

population affected by the disaster. The fundamental role of health centers is

surveillance. Historical evidence has demonstrated that an uncontrolled spread of

communicable diseases after a natural disaster has been the exception and not the

rule. Some health centers are equipped to treat people with minor injuries, which

is extremely useful to reduce congestion and referral to hospitals or other more

sophisticated medical facilities.

26

CHAPTER 3

METHODOLOGY

A. RESEARCH DESIGN

This study utilized a descriptive correlational approach of a quantitative research.

The researchers provide summaries and other critical information regarding study

samples and measures (Kothari, 2004). Descriptive correlational approach in this

research aims to provide static pictures of situations as well as establish the

relationship between different variables (McBurney & White, 2009). Descriptive

design was used to describe the internal and external factors and content of the flu

vaccine. on the other hand, correlational design was used to determine the

relationship between external and internal factors and patient’s decision on flu

vaccine
B. RESEARCH INSTRUMENT

The research instrument used in this study is in the form of survey questionnaires

via google forms. The objective of the proposed research is to give information

and details for its audience regarding influenza vaccine and its risk factors and

adverse effect. The respondents in this survey are parents and healthcare workers

such as doctors, nurses and pharmacists, most of them are female. The said

questionnaire was divided into three sections. The first section dealt with the

profile information of the respondents including the type of participant, sex, age,

monthly gross income, family structure. The second section of the questionnaire

focused on the opinion of the partakers in the questions that can be answered by 1

to 5, 1 as strongly disagree and 5 as strongly agree. Lastly the third section’s

questions focused on the factors that affect the patients’ decisions and their

background in taking vaccines.

27

C. DATA GATHERING PROCEDURE

Amidst the pandemic, the inquirers continued the survey through Google

form, as the current situation has disabled face-to-face activities. The three-part

questionnaire was approved by the research mentor. After which, individual’s age

eighteen years old and above were chosen to be the respondents of the said

survey. The gathered and collected personal data were kept confidential, whereas

the rest of the data were graphed and typed in Microsoft Excel and was submitted

to the adviser.

D. DATA ANALYSIS
 Responses to the questionnaire by individuals eighteen years old and above

were treated and carefully studied, statistically and systematically analysed using

correlational formula. Demographic profile of the participants was used, including

their age, sex, and monthly gross income, family structure, and whether they have

gone through vaccination or not. Descriptive statistics was used in analysing the

data; frequency count, mean, percent, and rank were considered.

28

Chapter 4

PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

INTRODUCTION

This chapter presents the analysis and interprets the data gathered in

order to draw out important information and significant points about factors that

affect the decision-making of parents and senior high school students of Baesa

Adventist Academy on having influenza vaccines. In this chapter we find the

correlation of the independent variables: accessibility and information and

knowledge, moderating variables which are the patient factor and the dependent

variable which is the decision making of the people. For clarity and consistency

in the discussion, the data and questions are presented by the Likert Scale

analysis.

The data below presents distributions of storytelling in terms of content

29

RESEARCH QUESTION NO. 1A

What is the demographic profile of the respondents in terms of age?

PRESENTATION

The table 1 is presented to answer the question: What is the demographic

profile of the respondents according to their age. Columns 2 and 3 of the table

depicts the frequency distribution and the percentage of respondents. Each

bracket has a corresponding weighted score for computation of the data purposes.

a. Below 18 is 1
b. Ages 18-30 is 2

c. Ages 31-45 is 3

d. Ages 46 and above is 4

Table 1

AGE FREQUENCY PERCENTAGE

BELOW 18 29 40.85%

18-30 29 40.85%

31-45 7 9.86%

46 AND ABOVE 6 8.45

TOTAL 71 100%

30

ANALYSIS AND INTERPRETATION

The table shows the age of the respondents. The age brackets: below 18 and

31-45, got the same frequency of 29 and a ratio of 40.85%. It also shows that

most of the survey population are aged 18-30. However, only 7 out of 71

respondents are aged 31-45 which has got the percentage of 9.86%. Lastly, the

least number of participants are aged 46 and above which is 8.45%.

RESEARCH QUESTION NO. 1B

What is the demographic profile of the respondents in terms of gender?

PRESENTATION

Table 2 is presented to answer the question: What is the demographic profile of

the respondents according to their gender. Columns 2 and 3 of the table depicts

the frequency or number of and the percentage of male and female students. Each

bracket has a corresponding weighted score for computation of the data purposes.

a. 0= Female

b. 1= Male

31

Table 2

GENDER FREQUENCY PERCENTAGE

MALE 38 53.50%

FEMALE 33 46.50%

TOTAL 71 100%
ANALYSIS AND INTERPRETATION

The table 2 shows the gender of the respondents. Out of 71 respondents 38 of

them are male which are 53.5% of the population. While the other 33 are female

which is 46.5% of the population of this research. This shows that there were

more males who took part in the study.

32

RESEARCH QUESTION NO. 1C

What is the demographic profile of the respondents in terms of type of

respondent?

PRESENTATION

Table 3 is presented to answer the question: What is the demographic profile

of the respondents in terms of type of respondent? Columns 2 and 3 of the table

depicts the frequency or number of and the percentage of type of respondents.

Table 3
 RESPONDENTS FREQUENCY PERCENTAGE

STUDENT 44 62%

PEDIATRIC 16 22.50%

ADULT STUDENT 11 15.50%

TOTAL 71 100%

33

ANALYSIS AND INTERPRETATION

Table 3 illustrates the type of respondents being surveyed in the study. On

the table, there are 44 students which are 62% of the population. Next, is the

pediatric section (mothers and fathers) that has got 16 as the frequency, which is

22.50% of the population. Lastly, there are 11 adult students who are 15.50% of

the population.

RESEARCH QUESTION NO. 2A

Table 4
 Will the decision-making of the student and of the parents be affected in

terms of Information and Knowledge?

PRESENTATION

Table 4 is presented to show how the researchers got the mean used for the

correlation of the variables. Columns 2-8 show the frequency, mean average, and

the verbal interpretation of the responses of the respondents on questions 1 and 2.

34
 INFORMATION AND KNOWLEDGE

Mean Verbal
QUESTION Frequency Average Interpretation

Strongly Strongly
Agree Agree Neutral Disagree Disagree

1 25 52 90 26 10 3 Neutral

2 100 108 66 4 0 3.9 Agree

Weighted Average 3.45 Agree

ANALYSIS AND INTERPRETATION

Table 4 shows the information and knowledge of the respondents. In question

no.1 got a mean average of 3; verbal interpretation is neutral. On the other hand, the

question no. 2 has a mean average of 3.9, verbal interpretation is agreed. The weighted

average of the two questions are 3.45 and shows as agreed in verbal interpretation. With

that, it can be assumed that the decision making of the participant can be affected in terms

of information and knowledge.

35
PRESENTATION OF CORRELATION BETWEEN DECISION-MAKING

AND INFORMATION AND KNOWLEDGE

Table 5 is presented to answer the question: Will the decision-making of the

student and of the parents be affected in terms of Information and Knowledge?

Highlighted in the table are the Multiple R and the Significance F of the

correlation between Information and Knowledge and Vaccination Decision-

Making.

Correlation between Information and Knowledge and Vaccination Decision-

Making
SUMMARY OUTPUT

Regression Statistics
Multiple R 0.119832198
R Square 0.014359756
Adjusted R Square -0.000134954
Standard Error 0.75874818
Observations 70

ANOVA
df SS MS F Significance F
Regression 1 0.570338723 0.570338723 0.990689441 0.323102665
Residual 68 39.14751842 0.5756988
Total 69 39.71785714

Coefficients Standard Error t Stat P-value Lower 95% Upper 95% Lower 95.0% Upper 95.0%
Intercept 3.112650396 0.28213975 11.0323001 8.4562E-17 2.549649289 3.675651502 2.549649289 3.675651502
0.47 0.614541839 0.617422837 0.995333834 0.323102665 -0.617506249 1.846589928 -0.617506249 1.846589928

ANALYSIS AND INTERPRETATION

The table 5 shows the relationship between Information and Knowledge

and Vaccination Decision-making among SHS students and their parents.

According to data above mentioned, the data got 0.12 of Multiple R, which

means, the information about influenza vaccination somehow affect their choice

of being vaccinated or not. The Significance F of the data was 0.32, the rejecting

of the null hypothesis is possible.

 36

RESEARCH QUESTION NO. 2B

Table 6

Will the decision-making of the student and of the parents be affected in

terms of Accessibility?

PRESENTATION

Table is presented to show how the researchers got the mean used for the

correlation of the variables. Columns 2-8 show the frequency, mean average, and

the verbal interpretation of the responses of the respondents on questions 1 and 2.

 ACCESSIBILITY

Mean Verbal
QUESTION Frequency Average Interpretation

Strongly Strongly
Agree Agree Neutral Disagree Disagree

1 25 48 78 40 8 2.8 Neutral

2 70 60 93 12 5 3.4 Neutral

Weighted Average 3.1 Neutral

37

ANALYSIS AND INTERPRETATION

Table 6 shows the accessibility of the respondents. Question 1 got an

average of, neutral. On the other hand, question 2 got 3.4, neutral. In conclusion,

the weighted average of accessibility of respondents resulted in 3.1 which means

neutral. It is concluded that the decision making of the patient is neutral in terms of

accessibility.

PRESENTATION
 Table 7 is presented to answer the question: Will the decision-making of the

student and of the parents be affected in terms of Accessibility? Highlighted in

the table are the Multiple R and the Significance F of the correlation between

Accessibility and Vaccination Decision-Making.

Correlation between Accessibility and Vaccination Decision-Making

SUMMARY OUTPUT

Regression Statistics
Multiple R 0.160261606
R Square 0.025683782
Adjusted R Square 0.011563257
Standard Error 0.146095684
Observations 71

ANOVA
df SS MS F Significance F
Regression 1 0.038822448 0.038822448 1.818897137 0.181854593
Residual 69 1.472732482 0.021343949
Total 70 1.51155493

Coefficients Standard Error t Stat P-value Lower 95% Upper 95% Lower 95.0% Upper 95.0%
Intercept 0.324049769 0.082797048 3.913784084 0.000210463 0.158874177 0.48922536 0.158874177 0.48922536
0.034842546 0.025834842 1.348664946 0.181854593 -0.016696554 0.086381645 -0.016696554 0.086381645

38

ANALYSIS AND INTERPRETATION

The table 7 shows the relationship between Accessibility and Vaccination

Decision-Making among SHS students and their parents. According to data above

mentioned, the data got 0.16 of Multiple R, thus, it does not influence the

surveyed population in their decision-making with regards to their accessibility.

The Significance F of the data was 0.18 so there is a slight possibility that the null

hypothesis be rejected.
 RESEARCH QUESTION NO. 2C

Table 8

Will the decision-making of the student and of the parents be affected in

terms of Patient Factors?

PRESENTATION

Table 8 is presented to show how the researchers got the mean used for the

correlation of the variables. Columns 2-8 show the frequency, mean average, and

the verbal interpretation of the responses of the respondents on questions 1, 2, and

3.

39

PATIENT FACTOR

Mean Verbal
QUESTION Frequency Average Interpretation

Strongly Strongly
Agree Agree Neutral Disagree Disagree

1 15 68 114 18 4 3.08 Neutral

2 75 128 57 6 2 3.77 Agree

3 35 28 48 58 12 2.54 Disagree
 Weighted Average 3.13 Neutral

ANALYSIS AND INTERPRETATION

Table 8 shows the patient factors of the respondents. Question 1 got an

average of 3.08, neutral. On the other hand, question 2 got 3.77, agree. Question

3 got 2.54, got disagreed. In conclusion, the weighted average of accessibility of

respondents resulted in 3.13. It is concluded that the decision making of the patient is

neutral in terms of patient factors.

PRESENTATION

Table 9 is presented to answer the question: Will the decision-making of the

student and of the parents be affected in terms of Patient Factors? Highlighted in

the table are the Multiple R and the Significance F of the correlation between

Patient Factors and Vaccination Decision-Making.

40
 Correlation between Patient Factors and Decision-Making

SUMMARY OUTPUT

Regression Statistics
Multiple R 0.052177513
R Square 0.002722493
Adjusted R Square -0.011730804
Standard Error 0.147807147
Observations 71

ANOVA
df SS MS F Significance F
Regression 1 0.004115197 0.004115197 0.188364826 0.665635137
Residual 69 1.507439732 0.021846953
Total 70 1.51155493

Coefficients Standard Error t Stat P-value Lower 95% Upper 95% Lower 95.0% Upper 95.0%
Intercept 0.411875 0.052257718 7.881610919 3.29114E-11 0.307623705 0.516126295 0.307623705 0.516126295
Mean 0.018058036 0.041607402 0.434010168 0.665635137 -0.064946461 0.101062532 -0.064946461 0.101062532

ANALYSIS AND INTERPRETATION

Table 9 shows the relationship between Patient Factors and Decision-Making among

SHS students and their parents. According to data above mentioned, the data got 0.05 of

Multiple R, it showed that regardless of their age and sex, it does not affect the

respondent’s decision whether they are to vaccinated or not. The Significance F of the

data was 0.33. The possibility of rejecting the null hypothesis is low

RESEARCH QUESTION NO. 3

Is there a significant relationship between the independent variables and

the dependent variable?

Table 10

41
PRESENTATION

Table 10 is presented to answer the question: Is there a significant relationship

between the independent variables and the dependent variable? Highlighted in the

table are the Multiple R and the Significance F of the correlation between the

independent and Vaccination Decision-Making.

SUMMARY OUTPUT

Regression Statistics
Multiple R 0.11795042
R Square 0.013912302
Adjusted R Square -0.000588988
Standard Error 0.147985201
Observations 70

ANOVA
df SS MS F Significance F
Regression 1 0.02101 0.02101 0.959384 0.330814177
Residual 68 1.489174 0.0219
Total 69 1.510184

Coefficients Standard Error t Stat P-value Lower 95% Upper 95% Lower 95.0% Upper 95.0%
Intercept 0.332402385 0.103929 3.198346 0.0021 0.125014385 0.53979 0.125014 0.53979
4 0.03100147 0.031651 0.979481 0.330814 -0.032156924 0.09416 -0.03216 0.09416

Table 10 shows the relationship between the independent variables and the dependent

variable among SHS students and their parents. According to data above mentioned, the

data got 0.12 of Multiple R, it showed that dependent variables does slightly affect their

decision in whether want to be vaccinated or not. The Significance F of the data was

0.33. The possibility of rejecting the null hypothesis is low

42
 CHAPTER 5

SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATION

Summary of Findings

According to the statistics shown in the previous chapter, most of the respondents

are in the age bracket of below 18 and 18-30 as they have the same frequency of 29 and

percentage of 40.85%, which makes up to. The population is dominated by male

participants, which makes up 53.50% of the population. As for the type of the

participants, the majority of them are students, which is 62% of the population. While

moderating variables, patient’s factors are grouped into the section of age and gender.

Information and Knowledge, which is classified into three: Experience,

Components of Vaccine and Health Literacy has had a Multiple R of 0.12 Which means,

it does not influence the surveyed population whether or not they have enough

knowledge about the vaccine.

Accessibility, which is classified into three categories: Healthcare expenses,

Socio-economic status, Public health facility has had a Multiple R of 0.16. In relation to

the dependent variable, decision-making, it does not influence the surveyed population

whether or not they are accessible.

As per the correlation between age and decision-making, it resulted in a multiple

r of 0.25; it showed that regardless of whether the surveyed population is young or old; it

does not affect their decision in vaccination. While the correlation between gender and

decision-making, it resulted in a multiple r of 0.13; which means, regardless of whether

the participant is male or female, it does not affect the decision about vaccination.

Therefore, patient factors do not affect the participant’s decision-making in vaccination.

43
 In the matter of the correlation between the independent and dependent variables, it

has been found out that the information and knowledge, accessibility do slightly affect

the decision making of the surveyed population. As it has only gotten 0.12 of Multiple R.

With regards to the Significance F of the data, the possibility of rejecting the null

hypothesis is somewhat low.

Conclusion

The study has shown that information and knowledge, as well as availability, had

some impact on the decision-making of the surveyed population. Therefore, we can

conclude that several people were somehow hesitant to take the vaccine based on their

vaccination experience, components of vaccine and health literacy. The study can also

say that participants are somehow hesitant because of too much expenses, their socio-

economic status, and the unavailability of public health facilities.

Due to some circumstances, the researchers were not able to provide broader and

enough questions to further discuss the study.

Recommendation

The following recommendations were made to help future researchers to finish

their research relating to this topic.

School

The researchers would like to recommend the school to give further,

thorough, and clearer research instructions to avoid such confusions. With

that, it is also suggested to let student researchers to experience defense in

every chapter.

44
Community

People should learn more about the vaccines they are about to take

before receiving any vaccination. People should have enough knowledge

before receiving any vaccination.

Future Researchers

Due to some certain circumstances, the researchers were unable to

investigate the factors pertaining to the questions, that resulted in limited

results and unexplored areas of study. Furthermore, it is proposed that if

other researchers will add to this analysis, they should use broader

questions about the variables that influence the respondent's decision-

making in influenza vaccination to gain more precise results.

45
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